Transcription:
Anxiety & Depression: Recognizing It In Yourself & In Others

Cheryl Martin (Host): It's normal to feel anxious or down from time to time, but severe or ongoing feelings like these can point to something deeper, anxiety or depression. Next, we learn how to recognize the symptoms and more from the Chief of Psychiatry at St. John's Riverside Hospital. Dr. Yadagiri Chepuru. This is riverside Radio HealthCast, the podcast from St. John's Riverside Hospital. I'm Cheryl Martin. Doctor first, what is anxiety and what is depression?

Dr Yadagiri Chepuru: Anxiety is a common emotional state we all experience throughout the day. The depression, people use term depression in kind of a lose way, but from a psychiatric perspective, the depression, we call it major depressive disorder, which is a disorder of the emotions on the brain and the body. So you all feel anxious and sometimes maybe you have a situation that happens in your life, you have a fight with loved ones or something happens at work, you feel depressed, but that's all transitory phenomena. Sometimes anxiety can be very healthy if you are anticipating participating in a seminar or you going to play a game and you feel anxious.

So good anxiety is helpful to perform better, but the persistent is the word, the persistent is the most important thing. People have persistent anxiety. So, for example, anxiety tend to be worry about the future. Anxiety means essentially you are worrying about something, worrying about future events, going the wrong way. Anticipating more, more distress when you have to do thing s in the future. whereas depression tend to be worry about what had happened in the past. Depression looks back, anxiety looks forward. So persistence of anxiety to a point where you become dysfunctional.

In other words, you're not able to function, you freeze, you cannot do anything. That then becomes more of a disorder. The depression is the same way. You might feel depressed for a day or a half a day, but you bounce back. But depression persists for days and days and days, along with some of the symptoms that can turn into a major depressive disorder.

Cheryl Martin (Host): And what are those signs and symptoms where it becomes a major disorder?

Dr Yadagiri Chepuru: So for example, we follow, what you call diagnostic DSM five, which are diagnostic criteria for psychiatrists to follow, to make a diagnosis of major depressive disorder. We go with, five or six symptoms, and there are two symptoms one of them has to be present at least for a period of two weeks. We call that depressed mood. If you have a depressed mood most of the day, in other words, you're feeling sad, you're feeling empty, you're feeling helplessness, and sometimes others might say, listen, they see you being tearful.

They see you being helpless and hopeless, but it has to be persistent day in and day out most of the day, at least for two weeks, not for a day or two, at least for two weeks. And in addition to that, you also have significant impairment, a diminished interest in, doing things that you like to do, interest in daily activities, pleasure in daily activities. Almost all of the day you call it anhedonia. You feel fatigued, you feel tired, you cannot enjoy your meals. You can enjoy your conversation with your wife and children.

You're not able to perform at work, that has to be persistent, not just for a day or two, but at least two weeks. That's the minimum requirement for one to consider. You may have a major depressive disorder at the moment. In addition to that, you might experience some significant weight loss. sometimes you lose weight, not when you're dieting. When you're dieting, that's a different issue. If you lose less than 5% of weight, without dieting, that's another indication that could be part of a depressed phenomena. Then you have the sleep impairment. It's very, very important. Sleep is very important for human beings.

In other words, you have difficulty falling asleep, the difficulty staying asleep. Sometimes you're also having early morning awakening. That's the most important impairment of sleep in depression. You get up earlier than usual, you're used to getting up maybe seven, eight in the morning, you're getting up three or four in the morning, can't go back to sleep. That happens day in and day out, or at least for two weeks. That's a significant impairment in sleep when you feel fatigued, because of not being able to sleep, feeling sad, not being able to function. Fatigue comes along the way and sometimes, you feel withdrawn.

You feel like you are not participating, you're not engaged. Sometimes in some patients that can turn into agitation. Some people become more, especially children, adolescents, they show depression, anxiety, more of agitated manner, they seem more restless and agitated. That could be a part of the depression too. But you cannot take any of the symptoms by themselves. There has to be a total syndrome. You call them symptom complex, that has to be there at least for two weeks for someone to have a diagnosis of major depressive disorder.

Cheryl Martin (Host): So how common is it for anxiety and depression to be connected and so both are being treated?

Dr Yadagiri Chepuru: Studies are showing that at least 40% of depressive individuals have generalized anxiety disorder. And up to 50, 60% of the time people have panic disorders or some kind of other anxiety conditions that kind of increase the distress from depression. So depression, anxiety tend to coexist. We call them comorbid conditions. So what we tend to do is to treat depression, if it is a major depressive disorder, that you are displaying these symptoms, you might treat you with medication to reduce the level of depression and anxiety.

We have medications, we call them serotonin [inaudible] inhibitors, that will help you with anxiety as well as depression. That's where we start. Sometimes some physicians, depending on severe anxiety, panic disorder, might even use benzodiazepine to start with. What I mean by is medications like a Xanax or Avana, Klonopin can be stored earlier to relieve intense anxiety, and the depression medicine takes a while. If I give an antidepressant, you don't get better within a day or two.

It takes about three to six to eight weeks for the depression to lift. So in the meantime, if you're having severe impairing anxiety not being able to function, we might help you relieve the anxiety with anti-anxiety medications while the depression medicine works on the brain. And eventually, when you feel less depressed, anxiety gets better, then we can discontinue the anti-anxiety medication that we gave you in the beginning of the treatment. So anxiety, depression, coexist is very, very common.

One thing I want to tell you before I make a diagnos of psychiatric disorder of major depressive disorder and anxiety, we have to make sure that individual's health is intact. Many times people have medical conditions, especially women have maybe low thyroid levels, hormonal changes, and B12 forecaster levels. So when somebody comes into my office saying that they're depressed, I take a evaluation, make a diagnosis, but I would like to get a complete medical workup, want to make sure that they are suffering from some underlying medical condition that can cause anxiety and depression, especially low thyroid in women can cause severe depression.

So we don't have to use antidepressant for the condition. You can use fero supplements, medication to relieve the low thyroid level, beat four levels, folic acid levels, it can relieve the symptoms of anxiety and depression, which are not a major depressive disorder, but secondary to underlying medical conditions. The other thing also is the medications some people, suppose you have hypertension, diabetes, arthritis. Some of the medical conditions, the medical doctors are giving you medications. Some of the drugs have a lot of side effects, cardiovascular drugs, blood pressure medications, and the diabetic medications can give you anxiety, depression.

So we need to rule out that what you're experiencing is not what we call organic condition, a medical condition not induced by medications. And even substance abuse is very, very, important. Somebody drinking alcohol using substances that can cause an anxiety depression as well. So when to rule out all the reversible causes of mood changes before you make a diagnosis of major depressive disorder.

Cheryl Martin (Host): That's great. You do that complete medical workup first.

Dr Yadagiri Chepuru: Absolutely. It's very, very important because you know one of do out pills. Unnecessary without understanding the total person. So depression is the brain and the medical, and the body condition. So are the medical conditions also, heart disease, hypertension, diabetes can cause an anxiety or depression as well. Yes, definitely.

Cheryl Martin (Host): Now, do you consider anxiety and depression mental illnesses?

Dr Yadagiri Chepuru: Absolutely. Only when I described to you the precision anxiety causing functional impairment. Everything comes down to are you impaired with this condition? Is anxiety causing you impairment in the sense that you're not able to go to work, you're not able to cross a bridge, you're not able to take an elevator, or you cannot, you're not able to, pay attention to your work? You're not able to perform. You need to look at the functional impairment, what is a change you are experiencing now from what it was a few weeks ago, month ago, before you start experiencing these symptoms? So you gotta see how you were functioning before. How are you functioning now? It should be functionally impairment for me to make a diagnosis of major depression or even major anxiety disorder.

Cheryl Martin (Host): Now do lifestyle changes make a difference?

Dr Yadagiri Chepuru: Absolutely. I think you know what people need to understand is that medication we give can be helpful but there not the panacea. The last four years during Covid, depression has almost doubled in this country. You have like 85, 90 million people suffering from depression. One of the most common reasons for Covid related depression islonlieness. When you're isolated, when you're lonely, can cause more distress. That can cause depression. So lifestyle changes, at least for now, most of my patients, I tell them, listen, if you can do some exercise, go for a walk. You don't have to go to gym every day. You have a bicycle. Do for half an hour, 20 minutes, do some yoga.

Look at your sleep habits. Why are you not sleeping? Are you eating more than you should be after 8:00 PM? Are you staying up late? are you doing anything else that interferes with your sleep? So a lot of lifestyle changes you can do to reduce the intensity of the depression.

Cheryl Martin (Host): And also I would think stop the isolation.

Dr Yadagiri Chepuru: Isolation, if you can, we say that especially people who live alone, especially elderly people, middle-aged people who live alone and they have no social life, isolation is the enemy of depression. If you could reduce isolation, interaction with the loud ones, and the friends can be very, very helpful in a relieving, an angry and depression. Isolation. Definitely highly stressful condition to people when you're living all your isolated life.

Cheryl Martin (Host): So are women more likely to suffer from anxiety and depression?

Dr Yadagiri Chepuru: Indeed, yes. Women tend to have higher incidence of depression, maybe because of the constant hormonal changes, the experience since puberty be one of the reasons, they tend to suffer from depression more frequently than men. But men when they get depressed, especially in their forties, fifties and sixties, can have a severe lethal depression than the woman do. So yes, it is more frequent, more, prevalent in women than men.

Cheryl Martin (Host): You mentioned some treatment options. Doctor, any more you want to cover even alternative treatment options?

Dr Yadagiri Chepuru: The problem with alternative treatments are if you go to a local health food store, you pick up these medicines that tell you that can cure anxiety, depression, everything in the world. My question is that they say this medicine has been studied. I don't know where this study was done, when it was published. So there's no data behind these claims that the companies say. Having said that, people should look at vitamin D levels. There's a lot of data behind Vitamin D deficiency can cause depression. Multivitamins are very important. Vitamin E can be helpful. Vitamin B12 can be helpful.

So there are vitamins that are important to vital functioning of the body, but these claims of these compounds in them. I don't really believe in that unfortunately. Most educated people go to these stores to buy these fancy capsules. We just don't even know what's inside them, and lifestyle changes are important. And also I think, as I said to you before, my medications are not going to cure you a hundred percent. So medication plus lifestyle changes, plus psychotherapy, supportive psychotherapy can be very, very helpful. Especially when you're encountering a job loss, loss of marriage, traumatic event, grief.

All these conditions do not require you to take medications, someone to talk to, someone to listen to, go to therapy can be very, very helpful. And you can just by talking about what's bothering you relieves, lot of anxiety and depression people, but I think you need to be able to see somebody who's not judgmental. And you said somebody can listen to you because we are all individuals, right? We all have different genetic patterns. We all inherit certain behaviors. We're complex people, so way, we see things are very, very different. For example, if 10 people exposed to particular stress, there are 10 different reactions to the particular stress.

Stress is the same , but the level of anxiety, depression, how you experience the stress you wanna talk about it is very, very different. So we gotta really, really go to individuals response to particular stress, depending on their personality, their genetic predispositions, the family structure, and other personality factors.

Cheryl Martin (Host): So, at what point should someone seek professional help?

Dr Yadagiri Chepuru: If your anxiety is persisting. And you feel that you're not able to function and there is significant change in your behavior and your functioning and your sleep and your appetite, and this all comes down to functioning. You're not able to function the way you used to function a month ago, two months ago. Your productivity has changed. You have lack of interest in doing things. So if there is significant impairment in the functioning, that's when we need to seek, psychiatric health. But if you have a grief or job loss, you don't have to come to me.

You can get a psychotherapist, somebody can, therapist can be very helpful in helping you understand how to deal with some of these stressors. And having said that, sometimes the grief can persist for more than six to eight weeks can turn into a major depression. Another important function I want, mention is your genetic history. Family history of depression, the family history of bipolar illness, family history of anxiety, family history of alcoholism, family history of complete suicide, plays significant role.

We inherit genetic predisposition to how to manage stress. If you have family history of these illnesses, be careful because you're more vulnerable to developing anxiety, tend into a impairing disorder. Little depression come into a major depressive disorder.

Cheryl Martin (Host): So this affirmation is good not only for someone who may be feeling these symptoms, but also for a loved one who can be aware and then encourage the person to seek help.

Dr Yadagiri Chepuru: Absolutely. I feel the loved ones. I call them silent sufferers. because they're not the identified patient they can see. Because if your loved ones this change in your spouses or your friends personality, right? It might be moody and anxious for a day or two, but the moodiness persists for more than two weeks and you're not sleeping, you're not eating well, you're not functioning more irritable, you're not productive. That's a significant change. They can be very empathic. When I accuse somebody, Hey, become Sorry. You're being lazy. Depression is not a lazy disorder.

Depression is not a deficit character. It's a neuropsychiatric medical condition. It's a disorder, and if you have a history of mental illness in the family, major depressive disorder, empathy can help someone to listen. I see the change in you and I see that you're suffering, its affecting our life. Affecting your life or my life. Quality of life is different. Maybe you need to seek professional help. Someone to talk to, to begin with. And if it gets worse, maybe medicine can be helpful.

Cheryl Martin (Host): The good news is both of these can be treated.

Dr Yadagiri Chepuru: Definitely. And also, again, another point to remember is that, if you family history of depressive disorders, depression can be a major depressive disorder can be a lifelong condition. So you need to be aware of that. Yes. They can be effectively treated. Yes. Because one of the things, acutely away is that the sad mood helplessness, hopelessness can lead to suicidal thoughts, suicidal behavior, complete suicide. That's a major risk factor for people suffering from major depressive disorder. So we pay attention to the inherent suicidal potential in any individual suffering from depression, especially if they have a family member, the first degree relatives, we call them parent, children, siblings, parents, and children have a complete suicide can inherit that genetic previous question to complete suicide. So you gotta be very careful with that.

Cheryl Martin (Host): Dr. Yadigiri Chepuru. Thank you so much. We appreciate your expertise and sensitivity and explanation. Defining anxiety and depression while common, that these symptom are treatable. Thank you so much.

Dr Yadagiri Chepuru: Thank you very much. Thanks for having.

Cheryl Martin (Host): For more information, please call our physician referral service at 914-964-4DOC that's 914-964-4362 or email us at Findadoc@riversidehealth.org. That's Findadoc@riversidehealth.org. If you found this podcast helpful, please share it with others and check out other episodes of Riverside Radio HealthCast, the podcast from St. John's Riverside Hospital.